(P 126) CURRENT PRACTICE IN SPERMATIC CORD SARCOMA: ONCOLOGICAL TIMELINES AND OUTCOMES ACCORDING TO INITIAL RESECTIONS PERFORMED AT A LOCAL HOSPITAL VERSUS EARLY PATIENT REFERRAL TO A TERTIARY CENTRE.

Objective: Spermatic cord sarcoma remains an exceedingly rare yet highly heterogeneous disease with an annual incidence of 0.3 cases per million men. Hence, an appropriate risk assessment and personalized treatment necessitate multidisciplinary care in referral centres for soft tissue sarcoma. Nevertheless, most patients receive inadequate surgery in local hospitals following the presentation of an asymptomatic inguino-scrotal lump and diagnosis is mainly determined postoperatively.

This retrospective study looked at the oncological outcomes of inguino-scrotal sarcoma cases managed with curative intent resection at a tertiary referral sarcoma centre. We specifically studied how inadequate resections impact the oncologic outcomes compared to primary tumour resections at the reference centre.

Methods: One hundred twenty-five consecutive patients affected by primary, localized spermatic cord sarcoma surgically managed at our reference centre from January 1982 through January 2021 were included.

Primary end-point measures the rate of disease relapse, with disease-free (DFS) and overall survival (OS) rates defined. These outcomes were evaluated with multi-nomial logistic regression and Cox proportional hazards regression models for a co-relation to the defined variables of age, tumour size, pathologic grade, resection margin status, initial inadequate surgery, adjuvant treatment given and the time interval from onset of symptoms to oncologic resection. We also compared the treatment intervals among the subgroups of primary versus re-resection surgery, along with defined patient, tumour and treatment-related variables (Table-1).

Results: Eighty-eight patients (70.4%) had their initial diagnosis established on an inadequate surgical excision performed in a local hospital, followed by a re-excision at our centre (Re-resection group). At the same time, 37 (29.6%) were managed primarily with biopsy and treatment at our reference centre (Primary-resection group).

The two groups showed statistically significant differences in tumour size distribution, histopathology, and postoperative complication rate (p < 0.05). However, a prompt referral after an initial surgery on a non-cancer pathway did not result in a statistically significant effect on treatment intervals (Table-1, Figure-1). In patients undergoing re-excision after inadequate primary resection, residual disease was found in 44 (50%) specimens. Following R0 resection, there was no statistically significant difference in the risk of recurrence between the two groups (p=0.34) (Table-2).

The rate of local recurrence (LR) and distant metastasis (DM) for the whole cohort was 11.2% each over a median follow-up of 54 months (IQR 25 -105). The cohort's local relapse-free and distant metastasis-free survival were 88.7% and 87.4%, respectively. Higher tumour grade and a marginal (R1) resection were associated with worse DMFS and LRFS, respectively (p= < 0.05) (Figure- 2).

5-year DFS was 78.9% for the study population, 51.6% in G3, 76.2% in G2 and 97.5% in G1 FNCLCC (p=0.001).

5-year OS was 91.8 % in the whole cohort and 66.1% in G3 FNCLCC, compared to 94.8% and >99.5% in G2 and G1 FNCLCC tumours, respectively (p=0.054).

Conclusion: Prompt referral to a tertiary centre, where multidisciplinary evaluation and an oncologically sound surgical resection is the standard of treatment, has the ability to align the OS and DFS of patients receiving incomplete surgery elsewhere to those treated primarily in referral centres. Nevertheless, the primary determinant of prognosis remains surgical margin and tumour grade for LRFS and DMFS, respectively.